Authorization for Release of Student Records
The undersigned hereby authorizes the Interstate 35 Community School District and any of its agents to release official student records of:
(Full Legal Name of Student) _______________________________________ (Date of Birth) _______________________________
(Name of Last School Attended) _______________________________ (Dates of Attendance) __________________________
The undersigned specifically authorizes the release of the following official student records of the above student: (If not records are specified, the undersigned authorized the release of all student records of the above student.)
The reason for the authorization _________________________________________________________________________________________
___________________________________________________________________________________________________________________
Copies of the records to be released are to be furnished to:
- the undersigned
- the student
- other (please specify) ____________________________________________________
The undersigned has the following relationship to the student:
____________________________________________ Signature ____________________________ Date
____________________________________________ Address _____________________________ City _______ State
____________________________________________ Phone
Revised/Reviewed: April 22, 2024